DULUTH NEWS-TRIBUNE
Copyright (c) 1999, Duluth News-Tribune

Tuesday, May 11, 1999
By Daniel Bernard/News-Tribune staff writer

COUNTIES COULD FACE CHARITY HEALTH-CARE TAB

   ST. PAUL -- Hospitals and clinics that absorb the cost of treating the uninsured went to the state for relief this year. The state is sending them to their neighboring counties.
   Under proposed legislation, certain health-care facilities could bill a charity-care patient's county of residence.
   Yet many of the affected parties are not enthused with the bill-your-neighbors solution.
   ``It's very minimal, the benefit that would come with it,'' said Wende Nelson, executive director of the Duluth Community Health Center, which would be granted the new billing powers.
   The Senate approved the proposal instead of the hospital's request for more state aid. A House-Senate conference committee working on this year's omnibus tax bill is considering including the proposal. Senate Tax Chairman Doug Johnson, DFL-Tower, indicated Friday that he expects some form of the provision in the final bill.
   The idea is being pushed by the state's two largest providers of health care to the poor, Hennepin County Medical Center in Minneapolis and Regions Hospital in St. Paul.
   In 1996, the most recent year for which figures are available, those hospitals accounted for about a third of the state's $70 million in treatment of people who have no means of paying.
   But the legislation would also grant the authority to Miller-Dwan Medical Center in Duluth and 12 other hospitals that have the state's highest proportion of poor patients.
   The ``bill-back'' authority would be extended to community health centers that provide free or sliding-scale care to the poor. But that could be in name only: Counties would only have to pay if their residents accounted for at least $10,000 in annual costs.
   Most patients at the Duluth Community Health Center, which is funded by foundation grants, donations and government contracts, live in St. Louis County, Nelson said. Many others come from Douglas County, Wis., where the proposed law would have no effect. Patients from Carlton and Lake counties account for a few hundred dollars, well below the minimum.
   Dave Beal, chairman of Miller-Dwan's board of trustees, said the private, nonprofit hospital isn't looking for a bailout and is prepared to continue absorbing charity-care costs. The center, which specializes in treatment of burns, chemical dependency and kidney dialysis, reported about $330,000 in charity care in 1996.
   And the plan has been criticized by all three political parties in the Minnesota Capitol.
   ``This would be kind of a messy system, to keep track of where people live, and verify it,'' said Rep. Lee Greenfield, DFL-Minneapolis.
   Rep. Fran Bradley of Rochester, Republican chairman of the House Health and Human Services Finance Committee, said he won't back more money for charity care until hospitals scrutinize whether patients who get free treatment are deserving.
   To nudge some patients onto public aid, a conference committee working on omnibus health legislation on Monday approved a greatly simplified application form to be placed in emergency rooms, Bradley said.
   Jan Malcolm, health commissioner for Gov. Jesse Ventura, prefers a broad discussion of uncompensated care issues this summer, a Health Department official said.
   St. Louis County lobbyist John Ongaro blasted the proposal as ``universal health care on the backs of property taxpayers.'' Billed counties would have to cover the costs with their local government budgets, funded by property taxes. Ongaro is worried about bills Hennepin County and Regions might send to St. Louis County.
   In Duluth, St. Mary's Medical Center reported providing nearly $1.61 million in charity care, while St. Luke's Hospital reported more than $430,000. But only Miller-Dwan qualifies in Duluth because Medicaid-eligible patients are such a high proportion of its total clientele, according to the Minnesota Department of Human Services.
   Also eligible would be Northern Itasca County Hospital in Bigfork.